Monday, September 10, 2012

No stranger bond

(This short story is entirely a work of fiction.)

"17th July, 2011. Today is going to be a special day!", Sharada Subramanyam thought to herself as she got out of her bed and started going about her daily routine. She was unusually cheerful. There was an extra bounce in the sixty-six year old's steps. There weren't many days like this though. She was on dialysis for about four and half years now.

She went to the kitchen and started straining the drinking water and filling the containers. Her daughter-in-law Madhu joined her after ten minutes or so and scolded her for getting started without her. "You really shouldn't be doing all this alone, amma! You know we allow you to do small chores around the house so that you feel as normal as possible but you shouldn't take undue risks."

"What risks, Madhu? When appa was alive, I used to do much more! You people have really spoilt me."

"There is no point telling you, I know. What time is your session1 today?"


"Bala will drop you off and I will pick you up as usual at around 12. I am thinking of making cabbage curry with chapathis and rice and drumstick sambar. Is that ok?"

"Perfect. You know I am ok with anything! Ask your fussy husband!"

"Yeah I know, amma", said Madhu as she smiled in appreciation.

Madhu was a huge fan of her mother-in-law. She couldn't help admiring how well she handled herself. Fate had dealt a cruel blow to her not once but twice over. Her husband, Subramanyam Ganeshan was diagnosed with chronic kidney failure at the age of 54. His doctor had managed to keep him off dialysis for five years with medication and strict diet control. However, soon after, the kidney function had deteriorated drastically and he had to be put on dialysis. Sharada Subramanyam was determined not to let the disease get the better of her husband. She nursed him and catered to every demand this disease made of them. After about four years of endless visits to the dialysis center and the concomitant side effects of kidney disease2, Subramanyam Ganeshan succumbed to a heart attack at the age of 63.

Sharada was devastated. For decades her life had revolved around her husband. She was married to him when she was 16. Life for a woman from her background meant - the husband. Everything was done keeping the husband in mind. From the time you woke up when you started thinking about what to cook for breakfast to the time you slept only after he slept - pretty much every breath you took was dictated by the husband. It was almost a devotional relationship.

When her husband died, Sharada felt an emptiness that was very difficut to fill. She couldn't figure out what to do with her life. It was as if there was no purpose left in her life. And then, life played a cruel joke on her. It gave her something to think about. It gave her something to deal with. It gave her kidney failure. A few months after her husband passed, she started feeling tired. Her son, daughter-in-law and even Sharada herself ignored it.

A few more weeks passed when her feet started swelling and she started feeling nauseous. Then one day, while working in the kitchen, Sharada collapsed! Luckily, her son and daughter-in-law were at home and they rushed her to the hospital where in the course of some blood tests, it was discovered that her Serum Creatinine3 was a mind-numbing 14.3 - more than ten times the normal!

Dr. Vinay Bhalla was immediately summoned. Bala and Madhu could never forget the expression on Dr. Bhalla's face as he looked up from the reports, examining them again and again to confirm if what he was seeing was indeed true. "This is unbelievable! Your mother needs dialysis immediately!"

A battery of tests and a biopsy4 later, it was confirmed that Sharada Subramanyam had Chronic Kidney Disease as well. It was likely that her kidney function had been declining for more than a year now and due to negligence, the deterioration had become quite rapid.

They immediately inserted a jugular catheter5 as access for dialysis and got her an arteriovenous fistula which would be used after a month or so. During all this, Sharada Subramanyam maintained a stoic calmness about her. It was deja vu for her as she went through everything her husband went through a few years back.

She knew everything about kidney disease. Who in her position wouldn't? Dr. Bhalla sympathized with her completely and tried to make things less difficult for her. But who could take away the complete toll kidney disease has on a person? Who could take away the fact that life changes forever? Changes in a way no one can ever fathom.

Sharada Subramanyam walked into the dialysis unit of New Delhi's Gangabai Memorial Hospital around 7:10 that day and wished the unit staff a good morning. The nurses noticed her in a really good mood. They felt happy for her. Within half an hour her session had started and she fell asleep.

Her morning nap was broken by some strange sounds. As she looked up, she saw about 5-6 hospital staff pull in a hospital bed with an old man into the unit. The man had all kinds of tubes attached to his body and he seemed unconscious. They placed the bed at one corner near a dialysis machine and the techs quickly got to work. They started dialysis on the man.

Sharada quickly went back to sleep. She did not realize that the man who had just entered the unit would change her life in more ways than one. Yes, as she had inexplicably guessed when she got out of her bed that morning, the day was going to be special indeed!

1 - Dialysis Session. Dialysis Patients typically go twice or thrice a week for dialysis treatments to a dialysis center or a hospital.

2 - Kidney failure usually has many side effects. The heart is the most commonly affected. Since the kidneys are not functioning, dialysis patients are often in a state called 'hypervolemia' or excess fluid in the body. Due tot his the heart has to pump more fluid than it is designed for. This often causes heart conditions such as Left Ventricular Hypertrophy. Many dialysis patients die not of kidney disease but of heart related complications.

3 - Serum Creatinine is a blood test used commonly to measure kidney function. For people with normal kidney function, it is usually between 05 to 1.2 mg/dl.

4 - A biopsy is a special test where a tiny bit of an organ such as the kidney is taken out and studied under a microscope to see the changes that might have occurred at the tissue and cellular level. This helps to make a more accurate diagnosis of the underlying disease.

5 - Jugular Catheter - is a thin catheter inserted into a vein on either side of the neck. Jugular catheters are typically used for dialysis to draw out blood from the patient and send it to a dialysis machine to clean it of toxins and excess fluid. Jugular catheters are typically used for short durations, from a few weeks to a couple of months until a permanent access to perform dialysis like an AV Fistula is ready.


Anonymous said...

i think we should start making short films

Anonymous said...

how about casting real patients in the short films?

Kamal D Shah said...

Great idea. Who is "we" btw? ;-)

Anonymous said...

"we" are u,me, kartik (he might know how to use the digital/3d camera to make a short film) and my friend suresh who is an assistant director (he can help us in technical details like lighting and just about a good camera to use for short films).

Wat say Dr.?